GRAY MATTERS: Home test for colon cancer can save lives

The verdict is in. The "colonoscopy or bust" approach isn't cutting it in Humboldt and Del Norte counties, but a risk-free, inexpensive test that can be done at home could be the answer to reversing a colon cancer rate that is among the worst in the state.

That's the hope of Aligning Forces Humboldt, which is based in the California Center for Rural Policy at Humboldt State. It teamed with the Community Health Alliance of Humboldt-Del Norte to get a $65,000 grant from the Robert Wood Johnson Foundation. The grant helped to launch a four-month campaign last October to raise public awareness about the need for colon cancer screening and the availability of the immunochemical fecal occult blood test -- iFOBT.

It's the hope of Eureka Internal Medicine, which was selected by the Institute for Healthcare Improvement to locally pilot information about three evidence-based colorectal screening tests and a website dedicated to colorectal screening info: http://gutcheck.nci.nih.gov.

It's also the hope of Anthem Blue Cross and the California Public Employees Retirement System. Last month, they sent the author of this column and another 39,999 CalPERS members its version of the iFOBT, a colorectal cancer screening kit from Quest Diagnostics called InSure FIT. The test can be done in the privacy of home. No muss, no fuss -- and in the CalPERS pilot, no visit to the doctor's office or elsewhere to pick up what costs anyone else $10.

All that's required is the ability to read and follow simple directions, five seconds of swabbing the stool in the toilet with an extended-handle brush, then dabbing the brush on a test card. The results will be mailed back three weeks after dropping it in the mail with pre-paid postage.

Colon cancer screening was never so easy. Even so, Anthem is only projecting a response rate of 3 to 6 percent, spokesperson Darrel Ng stated in an e-mail.

Results from Kaiser Permanente promise a better response over time. For the past several years, KP has sent fecal immunochemical testing kits to every KP member's home who should be screened. In Southern California in 2010, 70 percent of privately insured Kaiser Permanente members in the target group were tested, as were 84 percent of those on Medicare, said Joanne Schottinger, the assistant medical director for quality at KP, in a report by Kaiser Health News.

That's significantly higher than the 59 percent nationwide who were up to date with screening in 2010. About 50,000 Americans die each year from colorectal cancer, but the Centers for Disease Control and Prevention estimates as many as 60 percent of those deaths could be prevented if those age 50 and older were screened.

The iFOBT is one of three screening measures recommended by the U.S. Preventive Services and Task Force, but few people have made use of it, perhaps because they don't know about it. The home test looks for invisible blood in the stool, which can be a sign of a growth, polyp or cancer in the colon or rectum. It is recommended annually.

If blood is found, a colonoscopy is scheduled for a follow-up.

A colonoscopy is recommended every 10 years beginning at age 50, costs $1,500 to $3,000 before insurance, involves a day or two of prep time, sedation and some risk. Gut Check at the National Institutes of Health defines the risk of excessive bleeding at 1 in 100 people who have polyps removed and a bowel tear at 1 in 1,000. It is not recommended for people age 75 and older.

Flexible sigmoidoscopy is recommended every five years, According to Gut Check, it requires milder prep and no sedation or recovery, carries a 1 in 10,000 risk of excessive bleeding, and costs $500 to $750 before insurance.

The latter two are invasive. The first is not. With the newer versions of the stool test now available, it has far less of an "ooh" factor than changing a diaper or cleaning the litter box.

Most people with precancerous polyps or early colorectal cancer don't have symptoms, which is why screening can have such an impact. From 2003 to 2007, the California Cancer Registry tags Humboldt and Del Norte counties with an age-adjusted rate of 53.01 cases of colorectal cancer per 100,000 people. That was the state's worst.

Two years later, the rate improved to 48.25, leaving Humboldt and Del Norte with the state's fifth-worst rate.

A survey of the local patient population by the Humboldt-Del Norte Independent Practice Association found that in 2009, only 52 percent of patients were screened and colonoscopy was the screening choice 85 percent of the time.

"Our apparent community standard suggests that only colonoscopy is worthwhile to pursue, and the nearly half of the patients who decline to be scoped for either financial reasons or simple dread of the procedure perhaps are not being offered the far less costly or invasive FOBT alternative," wrote Dr. Alan Glaseroff in a three-page report available online at http://aligningforceshumboldt.org. "Rather, patients who refuse to schedule a colonoscopy are frequently marked down as 'declines screening.'"

FOBT, the precursor to the more sensitive and easier to do iFOBT, was the choice 12 percent of the time and flexible sigmoidoscopy came in at 3 percent.

"Most likely, there is a strongly held belief that colonoscopy is the 'gold standard,'" Glaseroff said. "The general public (and apparently the medical community as well) views colonoscopy as synonymous with colon-cancer screening in much the same way Xerox is synonymous with copier."

Katie Couric is widely credited for raising awareness of colon cancer. She underwent a colonoscopy on national television after losing her husband to a cancer that is the third most common in the U.S. and the second deadliest.

"We looked at the different conditions in our community and focused on colon cancer as the one we could change by getting information out about the three tests," said Jessica Osborne-Stafsnes, project manager for patient engagement at Aligning Forces Humboldt. "When we started our focus groups, what we heard time and again was people didn't even know the home test existed."

It does. It's easy. Done annually, it's effective.

Get screened. Now.

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Area 1 Agency on Aging commissions Carol Harrison to produce Gray Matters every two weeks.